No Coverage for Non-Congenitial Transexualism

[Misato]

I have an appointment with the Director of HR at my new job that should be awesome but is right now the bane of my financial existence on Tuesday.

Short of the situation is, well here's some quotes from the e-mails I was sending to my recruiter before I took the job because I was very extremely worried about losing the medical coverage I needed.

I've not had to manage health care between jobs before so I'm covering new ground for me.

I think we should give Paige the |snip| website and she can start researching the specific providers she is looking for in-network.

I was given a moment to look and found both clinics I was looking for on the |snip| website.  I was only concerned about my therapist...

In the e-mail chain that was the core of the discussion.  Now on Tuesday I find:

... Treatment for non-congenital ... gender dysphoria...

And it goes on to very precisely cut out everything we'd need item by item.

I know what non-congenital means in English but what the heck does "non-congenital" really mean as it pertains to me rectifying the sizable pay cut I've ended up taking because of the explosion in my out of pocket medical expenses?  For want of a better phrase if I can argue to the Director of HR that I was in fact "born this way", I may have a shot.  But any ideas on how I can argue this would be appreciated.

I have an ally coming with me.  Together we're going to be talking about this and the non-coverage of Domestic Partners.  Apparently, round here it's so common the guy I'm going in with never even thought to ask!

From my seat, all they had to do was send me the exclusion list.  That's it.  I don't think a cis person would have been offended by that.  I said I cared about my therapist.  They KNEW!  They KNEW what they were setting me up for!  (The intensity is coming off stronger in my keyboard than I actually feel.  I feel more panicked than anything and have for days.  It's exhausting.)

I just want some peace and to introduce some stability into my life.

Any ideas, please send em' on my way.

[Shantel]

My question would be did your HR person know up front that you are transexual, and were you clear about it so that there was no confusion? If so then perhaps you have a foundation for some legal recourse which you might research and be able to leverage the company in some fashion.

[FrancisAnn]

It sounds real tricky, no valid suggestions here. Good luck girl friend, try & be cool.

[Anna++]

I have no idea what to say to them, but I agree with Shan: if they knew going in that you're trans but withheld useful information then you might be able to do something about it.

* hug *  Good luck! 

[Misato]

My question would be did your HR person know up front that you are transexual, and were you clear about it so that there was no confusion? If so then perhaps you have a foundation for some legal recourse which you might research and be able to leverage the company in some fashion.

I didn't flat out say, "I'm trans."  I did say they were going to need another name from me for my background check and I talked about my trans research.  Then, well, look at me.  Heck I got clocked by getting "he'd" on my first day and confused by one for a guy who started work with on the same day as I did and, said guy, was standing right next to me!!??!!!??

I really don't want to get lawyers involved.  I'd rather just find a different job if I can't resolve this.

My thoughts are they had enough reason to think I might be interested in knowing about the exclusions and I hold they could have given them to me without suggesting I might be trans.  I get they're not supposed to ask so it's a hairy situation, but I don't think a cisgendered person would have been offended by getting that list.  "Here.  This detail might be helpful for you because some of those providers we sent you are exempt from our policy."

[Shantel]

Best you can do is discuss it with them and see if you can't reach some amicable resolution or move on. Good luck!

[Flan]

I know what non-congenital means in English but what the heck does "non-congenital" really mean as it pertains to me rectifying the sizable pay cut I've ended up taking because of the explosion in my out of pocket medical expenses?  For want of a better phrase if I can argue to the Director of HR that I was in fact "born this way", I may have a shot.  But any ideas on how I can argue this would be appreciated.

That basically they are claiming that if you weren't born with it that they won't cover it (which is a 180 from the current SOC and the Affordable Healthcare Act). I would bring both since the plan is discriminatory towards existing conditions.
http://www.healthcare.gov/blog/2012/11/marketrules112012.html
http://www.hrc.org/resources/entry/health-insurance-discrimination-for-transgender-people

[Cindy]

I would take the WPATH guidelines as well where I think (memory only I don't have them in front of me) that it states that gender dysmorphia is a life long condition, cannot be caught and hence has to be present at birth.

[Padma]

I'm just being the devil's advocate here, but it occurs to me that if they've never had trans employees before, and given the hugeness and fine-printiness of insurance paperwork, it's possible that they simply didn't know what exclusions existed in their policy, because they'd never read that part closely before. I'm just saying it may not have been deliberate.

[Misato]

Ooooooooh!  I'z still sleepy but it looks like there is some good stuff here!  Good morning indeed!

I had similar thoughts to yours Padma.  This company only recently started a hiring spree and the average term of employment is 11 years.  But, the company provides it's own insurance so I think they know, what they may be blind to is how the world has changed.

The "pit in my stomach" is they were really thorough in cutting out coverages for non-traditional families and abortions so I may be dealing with a Hobby Lobby or Chic-Fil-A situation.  If that's the case, but a cardboard sign on me: "will work on CRUDs" (never mind the acronym if you don't know it just take it at the word)

[Padma]

Certainly whoever drafted the insurance rules was making a point if they chose to use a phrase like "non-congenital ... gender dysphoria". But it's not the sort of thing you'd necessarily pick up unless it applied to you personally, so it might not reflect the feelings of the company as a whole, and is worth questioning - both for your sake and for that of future trans employees.

[JoanneB]

It is my direct experience as well hearing from others that some doctors/providers do code treatments so that they will be covered in spite of all the exclusions about all insurance policies have for treating transsexualism. I wouldn't go right into panic mode yet before talking o yours. For instance my therapy is submied for depression.

[Misato]

I asked the HR person who came in to tell us our benefits if the denial would impact my therapy visits, she said yes.

[aleon515]

I have heard of therapy visits being covered. I don't know how they can come up with a "noncongenital" thing for trans. I think few mental health conditions (if you call being trans a mental health condition, which I don't) are congenital.

I get my labs and my doctor covered. My T is not covered, but more because I am getting compounded cream and compounding pharmacies are usually not covered regardless.


--Jay

[Misato]

This one from the Human Rights Campaign is almost verbatim to one I'm up against:

... Care, services or treatment for transsexualism, gender dysphoria or sexual reassignment or change, including medications, implants, hormone therapy, surgery, medical or psychiatric treatment.

My "non-congenital" qualifier is injected into that.

I do recall when I was at University I found exclusion language in that policy as well, but I didn't have a problem being covered.  I still hope I've been wigging out for a week over nothing and I can finally get on with my life again.  I just wish this clarification had happened before I took the job, like I thought it had.

[aleon515]

Though most doctors can code things to cover certain stuff. I mean I don't think the labs, my doctor appts, etc. are covered for "transgender" they are like stuff like "hormonal imbalance" and stuff like that. I think therapy can be for anxiety and there is something like "adjustment reaction in adulthood". I think that could cover just about everything. I am getting my counseling thru a trans center.


---Jay

[Shantel]

Though most doctors can code things to cover certain stuff. I mean I don't think the labs, my doctor appts, etc. are covered for "transgender" they are like stuff like "hormonal imbalance" and stuff like that. I think therapy can be for anxiety and there is something like "adjustment reaction in adulthood". I think that could cover just about everything. I am getting my counseling thru a trans center.


---Jay

Good points! As a former claims adjuster I can assure you that it's the descriptive language in the claim as submitted through the health care provider that makes all the difference. So this is probably a matter of working with your health care provider once you know for certain what the insurer's parameters are of what is covered and that which is excluded.

[Misato]

Though most doctors can code things to cover certain stuff. I mean I don't think the labs, my doctor appts, etc. are covered for "transgender" they are like stuff like "hormonal imbalance" and stuff like that. I think therapy can be for anxiety and there is something like "adjustment reaction in adulthood". I think that could cover just about everything. I am getting my counseling thru a trans center.

I called my therapist and she said the same.  It's just a question of by the fact that trans issues are involved at all, will that cause exemption?  She said some places are that cruel.  I'm growing more and more concerned my employer would be.

Onto the domestic partner side... This is what my colleague got from them when he first said they should cover Domestic Partners:

What I can tell you is our self-funded plan is regulated by ERISA, a federal law that stipulates that marriage is between a man and a woman.  If the federal law changes to include same-sex marriage, we won't be able to, not don't want to, do anything other than what the law provides.

I was very careful typing that.  First, ERISA does not stipulate that marriage is between a man and a woman.  DOMA does, and ERISA is affected by DOMA as ERISA ignores state law (not that it matters in MN), but even in that case there is nothing prohibiting my employer from offering coverage.  I know for sure because General Mills is regulated by ERISA and they cover domestic partners.  I shall be bringing in documents attesting such.  Please correct me if I'm wrong.

But I know they're going to confuse me.  They're going to say some corner case that without knowing the law in and out is going to trip me up.  Grrrrrrr.  That's not exactly going to help me trust them at this point either.

My recruiter is new to the company too.  It's possible she doesn't know details, but to give us something so wrong.  What's going on here?  I want to be wrong on what I suspect, I want to be wrong.

[Misato]

The no coverage is bad enough but the misdirection (is that a good word?) just bugs the tar out of me.

[Anna++]

The no coverage is bad enough but the misdirection (is that a good word?) just bugs the tar out of me.

As it should.  I'm not thrilled by what your employer is saying either